Impacto psicosocial y económico de la uveítis en México / Psychosocial and economic impact of uveitis in Mexico

Resumen Objetivo: Conocer el impacto psicosocial y económico quede la uveítis en México. Métodos: Encuesta en pacientes diagnosticados con uveítis. Se registraron datos demográficos y nivel socioeconómico. Se identificaron síntomas, tiempo al diagnóstico, tratamiento, comportamiento, actitudes y sentimientos ante la enfermedad. Resultados: Se realizaron 100 encuestas a pacientes con uveítis, con edad media de 45 ± 17.08 años, nivel socioeconómico ≤ D; 54 eran mujeres. El diagnóstico se realizó al 1.87 ± 2.73 años. Acuden anualmente a cita 2.1 ± 2.14 mes, más de 1 a urgencias y son hospitalizados 3.7 días. Utilizan tratamiento sistémico con antiinflamatorios esteroideos (53 %), inmunosupresor (31 %), terapia biológica (7 %), tratamiento tópico con lubricantes (44 %), esteroides (26 %) y cirugías (39 %). Comorbilidades observadas: hipertensión arterial, diabetes mellitus, artritis reumatoide (18 %), síndrome de Sjögren, lupus y colitis ulcerativa crónica inespecífica. Complicaciones: deterioro visual, cataratas y ceguera. La uveítis afecta su vida en el 83 % de los casos, en el 41 % a diario y el 49 % necesitan cuidados de otra persona. El 79 % reciben atención privada, el 43 % cuenta con seguridad social, gastando mensualmente $3,590 ± $2,730.65 pesos en medicamentos, transporte, consulta médicas y estudios. Anualmente con ausentismo laboral de 8.5 ± 14.56 días, más 7.0 días de incapacidad u hospitalización. El 51 % refieren falta de apoyo para conocer la enfermedad. Conclusiones: Se trata del primer estudio nacional que escenifica la condición de los pacientes con uveítis y las insuficiencias por las que atraviesan, incluyendo el ámbito económico y biopsicosocial.

Abstract Objective: Determine the psychosocial and economic impact suffered by patients diagnosed with uveitis in Mexico. Methods: Survey in uveitis-diagnosed patients. Demographic data and socioeconomic level were recorded. Symptoms, time to diagnosis, type of treatment, behavior, attitudes and feelings towards the disease were identified. Results: One hundred surveys were conducted in patients with uveitis, who had a mean age of 45 ± 17.08 years, and socioeconomic level ≤ D; 54 were females. Diagnostic delay was 1.87 ± 2.73 years. Annually, patients attend 2.1 ± 2.14 appointments per month, and are admitted once to the emergency department and remain hospitalized for 3.7 days. Patients use systemic treatment with steroidal anti-inflammatory drugs (53 %), immunosuppressant agents (31 %), biological therapy (7 %), topical treatment with lubricants (44 %) or steroids (26 %) and undergo surgery (39 %). Observed comorbidities include hypertension, diabetes mellitus, rheumatoid arthritis (18 %), Sjögren’s syndrome, systemic lupus erythematosus, and nonspecific chronic ulcerative colitis. Complications: visual impairment, cataracts and blindness. Uveitis affects their life in 83 % of cases, in 41 % does it daily, and 49 % need care from another person. Seventy-nine percent receive private care and 43 % have social security, with $ 3,590 ± $ 2,730.65 pesos being spent monthly on medicines, transportation, medical appointments and studies. Annually, work absenteeism is 8.5 ± 14.56 days, plus 7.0 days of disability or hospitalization; 51% refer lack of support to learn about the disease. Conclusions: This is the first national study to portray the condition of patients with uveitis and the shortcomings they go through, including the economic and biopsychosocial fields.

Sífilis, la gran simuladora / 8 SYPHILIS, THE GREAT SIMULATOR. Case report of a patient with syphilitic uveitis

La sífilis desde hace siglos desafía a la humanidad, es transmitida por vía sexual y verticalmente durante la gestación.9 Esta enfermedad se hizo conocida en Europa a finales del siglo XV,13 y su rápida propagación por todo el continente la transformó en una de las principales plagas mundiales.Era preocupante el crecimiento de la endemia sifilítica en el siglo XIX 13.1. En contrapartida la medicina se desarrollaba, y la síntesis de las primeras drogas se hacía realidad. El mayor impacto tal vez fue la introducción de la penicilina en 1946, la cual por su eficacia hizo a muchos pensar que la enfermedad estaba controlada. En un estudio de revisión de literatura se dice que a raíz de la introducción de la penicilina la incidencia de sífilis (y de uveítis sifilítica) fue disminuyendo constantemente hasta finales de los años 90.3 resultando en la disminución del interés por su estudio y control. Con la aparición del síndrome de inmunodeficiencia adquirida (SIDA).2 se incrementó dramáticamente la evolución de esta enfermedad.En la literatura oftalmológica se comenzaron a documentar cada vez más casos e incluso se ha llegado a hablar de la «nueva epidemia de sífilis ocular¼1 Se estima que, anualmente, unos 357 millones de personas contraen alguna de las cuatro infecciones de transmisión sexual (ITS) siguientes: clamidias, gonorrea, sífilis o tricomoniasis.7 En el mundo hay una incidencia anual de aproximadamente 12 millones de pacientes con sífilis el 90% ocurre en países en desarrollo (OMS).

Syphilis has defied humanity for centuries, is transmitted sexually and vertically during pregnancy. This disease became known in Europe at the end of the 15th century,13 and its rapid spread throughout the continent transformed it into one of the main world plagues. The growth of the syphilitic endemic in the 19th century was worrisome.13.1 In contrast, medicine developed, and the synthesis of the first drugs became a reality. Perhaps the biggest impact was the introduction of penicillin in 1946, which, due to its effectiveness, led many to believe that the disease was controlled. In a literature review study, it is said that following the introduction of penicillin the incidence of syphilis (and syphilitic uveitis) was steadily decreasing until the end of the 90s.3 resultando in the decrease of interest in its study and control. With the onset of acquired immunodeficiency syndrome (AIDS). the evolution of this disease increased dramatically. In the ophthalmological literature, more and more cases have been documented and there has even been talk of the "new epidemic of ocular syphilis".1.1 It is estimated that some 357 million people each year get one of the four sexually transmitted infections (STIs) following: chlamydia, gonorrhea, syphilis or trichomonas's. In the world there is an annual incidence of approximately 12 million patients with syphilis 90% occurs in developing countries (WHO)

Optimizando el manejo de la uveítis con agentes biológicos en Chile del 2020 / Optimizing uveitis management with biological agents in Chile in 2020

Los agentes biológicos han irrumpido como una alternativa eficaz en el tratamiento de las uveítis no-infecciosas, especialmente en cuadros refractarios a inmunosupresores convencionales, con buena tolerancia y rápido efecto. Hay patologías como la enfermedad de Behçet en que incluso pueden estar indicados como tratamiento de primera línea. Este artículo ayudará a reconocer las patologías específicas donde presentan mayor eficacia, entrega herramientas para escoger el agente más adecuado para cada paciente y sugiere estrategias para evitar la pérdida de control de la enfermedad en el largo plazo.

Biological therapies have emerged as an effective option for the treatment of non-infectious uveitis, especially in refractive cases to conventional immunosup-pressive drugs. They are fast-acting, well tolerated, and can be considered as first-line agents for the treatment of certain uveitis like in Behçet ́s disease. This article will aid in identifying the uveitis syndromes where biological therapy is more effective, help choosing the most appropriate agent for a particular case and offer suggestions on how to keep long-term disease control.

Toxoplasmosis ocular recurrente. Presentación de 3 casos y revisión de la literatura / RECURRENT OCULAR TOXOPLASMOSIS: REPORT OF 3 PATIENTS AND REVISION OF THE LITERATURE

La toxoplasmosis ocular recurrente es la forma más común de toxoplasmosis ocular. Las lesiones se localizan adyacentes a una cicatriz coriorretinal resultado de una infección previamente adquirida. La retinitis por toxoplasma provoca una respuesta inflamatoria variable, ocasionando vasculitis, vitreítis, coroiditis y uveítis anterior. El diagnóstico se realiza examinando el fondo de ojo, y su etiología debe considerarse cuando en un adulto joven inmunocompetente, se observa en la fundoscopía la presencia de una lesión retinal focal, asociada a una cicatriz coriorretinal. La retinografía permite documentar los hallazgos observados en el fondo de ojo. El examen serológico para identificar anticuerpos anti toxoplasma de clase IgM e IgG solo confirma la exposición al parásito pero no constituyen pruebas diagnósticas confirmatorias. Se presentan 3 casos de toxoplasmosis ocular recurrente en pacientes adultos cuyos diagnósticos se realizaron mediante el examen fundoscópico y la retinografía.

Recurrent ocular toxoplasmosis is the most common form of ocular toxoplasmosis. Lesions are located adjacent to a chorioretinal scar as a result of a previously acquired infection. Toxoplasma retinitis produces a variables inflammatory response, leading to vasculitis, vitreitis, choroiditis and anterior uveities. Diagnosis is performed by fundoscopy and its ethiology must be considered when fundoscopy shows the presence of a focal retinal lesion associated to a chorioretinal scar in a young immunocompetent adult. Retinography allows documenting findings from the fundoscopy. Serological examination to identify anti toxoplasma antibodies classes IgM and IgG only confirms exposure to the parasite but do not constitute confirmatory diagnostic evidence. We present 3 cases of recurrent ocular toxoplasmosis in adult patients that were diagnosis by fundoscopic examination and retinography

Ocular syphilis in spouses: diagnosis, treatment and medical confidentiality / Sífilis ocular em cônjuges: diagnóstico, tratamento e sigilo médico

The aim of this paper is to report two cases of neurosyphilis and uveitis diagnosed by an ophthalmologist in an immunocompetent couple. In addition to reporting cases the authors discuss ethical issues of communication of diagnosis to partners of patients (AU)

O objetivo do presente artigo é relatar dois casos de neurosífilis e uveíte diagnosticados por oftalmologista em casal imunocompetente. Além de relatar os casos, os autores discutem questões éticas da comunicação do diagnóstico aos parceiros dos pacientes (AU)

Evaluación farmacoterapéutica y evolutiva de uveítis crónicas y recurrentes no infecciosas / Pharmacological treatment evaluation and progression of non-infectious recurrent and chronic uveitis

OBJETIVOS: evaluar el tratamiento farmacológico e identificar los factores pronósticos en una evolución clínica desfavorable con uveítis crónicas y recurrentes no infecciosas, en el Instituto Cubano Oftalmología "Ramón Pando Ferrer" durante el período 2012-2013. MÉTODOS: se realizó un estudio de utilización de medicamentos. Se efectuó un diseño de cohorte retrospectivo evaluativo y un estudio transversal analítico de factores pronósticos. Fueron evaluados 116 pacientes. Las variables utilizadas correspondieron a la evaluación farmacoterapéutica: selección del medicamento, pauta de administración y causas de incumplimiento terapéutico. Para la evolución clínica desfavorable se analizaron variables sociodemográficas y clínicas. Se calcularon frecuencias absolutas y relativas. Se realizó un análisis univariado. Las variables significativas a la evolución se incluyeron en el modelo de regresión logística múltiple. RESULTADOS: no existieron errores en la prescripción en el 100 % de los evaluados. El 15,5 % de los pacientes no cumplieron con el tratamiento prescrito; 83,3 % se relacionó con la presencia de reacciones adversas y 33,3 % con la falta de disponibilidad. El 57 % presentó efectos adversos por corticoesteroides y el 39 % por inmunosupresores. El curso clínico crónico y la localización resultaron factores influyentes en una evolución desfavorable. CONCLUSIONES: la evaluación farmacoterapéutica en el caso de las uveítis crónicas es adecuada. No existen errores en la prescripción. Las causas más frecuentes de incumplimiento terapéutico son la suspensión del tratamiento por efectos adversos, la falta de disponibilidad de inmunosupresores y la alternativa biológica. El curso clínico crónico y la localización de las uveítis pueden considerarse como un factor pronóstico en la evolución desfavorable de esta enfermedad.

OBJECTIVES: to evaluate the pharmacological treatment and to identify the predictive factors in unfavorable clinical progression of patients with non-infectious recurrent and chronic uveitis at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology in the period of 2012 to 2013. METHODS: drug use study was conducted based on a design of retrospective evaluative cohort and a cross-sectional analytical study of predictive factors. One hundred and sixteen patients were evaluated. The variables corresponded to the pharmacological treatment evaluation: selection of drug, administration guidelines and causes of non-adherence to treatment. For the unfavorable clinical progression, the sociodemographic and clinical variables were considered. Absolute and relative frequencies were calculated; the univariate analysis was made and the significant variables for progression were included in the multiple logistic regression model. RESULTS: there was no error in prescribing 100 % of the evaluated cases. In the group, 15,5 % of patients did not adhere to the prescribed treatment; 83,3 % due to adverse reactions and 33,3 % to lack of drug availability. Fifty seven percent suffered adverse effects from corticosteroids and 39% from immunosupressors. The chronic clinical course and the location were the most influential factors in the unfavorable progression. CONCLUSIONS: the pharmacological treatment evaluation for the chronic uveitis is adequate. There are no errors in prescription. The most frequent causes of non-adherence to treatment are cessation of treatment on account of adverse effects, lack of availability of immunosupressors and biological alternative. The chronic clinical course and the location of uveitis can be considered as predictive factors in the unfavorable progression of the disease.

Clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center in Brazil / Características clínicas e epidemiológicas das uveítes em um serviço de urgência oftalmológica no Brasil

Purpose: To analyze the clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center. Methods: We conducted a prospective, observational study of patients with active uveitis admitted between May 2012 and July 2012 to an emergency eye care center. Results: The majority of patients were male (63.2%), with a mean age of 43.2 years; 66.2% patients were of mixed ethnicity, 22.5% were Caucasian, and 11.3% were black. Anterior uveitis was observed in 70.1% patients, posterior uveitis in 26.5%, and panuveitis in 3.4%; no patient was diagnosed with intermediate uveitis. All patients had a sudden and acute presentation. The most frequent symptoms were ocular pain (76.9%), redness (59.8%), and visual blurring (46.2%). The majority of patients had unilateral disease (94.9%) with a mean symptom duration of 6.2 days. Diffuse and anterior uveitis were associated with ocular pain (p<0.001). Scotomata and floaters were more frequent in patients with posterior uveitis (p=0.003 and p=0.016, respectively). Patients with anterior uveitis presented with better visual acuity (p=0.025). Granulomatous keratotic precipitates were more frequent in patients with posterior uveitis (p=0.038). An etiological diagnosis based on the evaluation at the emergency center was made in 45 patients (38.5%). Conclusions: Acute anterior uveitis was the most frequent form of uveitis. Initial patient evaluation provided sufficient information for deciding primary therapy and aided in arriving at an etiological diagnosis in a considerable number of patients. .

Objetivo: Analisar as características clínicas e epidemiológicas das uveítes em um serviço de atendimento oftalmológico de urgência. Métodos: Estudo prospectivo, observacional de pacientes com uveíte ativa admitido entre maio e julho de 2012, em um serviço de atendimento oftalmológico de emergência. Resultados: A maioria dos pacientes eram do sexo masculino (63,2%) e a média de idade foi de 43,2 anos; 66,2% dos pacientes tinham etnia mista, 22,5% eram brancos e 11,3% negros. Uveíte anterior foi observada em 70,1% dos pacientes, uveíte posterior em 26,5%, e panuveíte em 3,4%, nenhum foi diagnosticado com uveíte intermediária. Todos os pacientes tiveram apresentação súbita e aguda. Os sintomas mais frequentes foram: dor ocular (76,9%), hiperemia conjuntival (59,8%) e baixa visual (46,2%). A maioria dos pacientes tinha doença unilateral (94,9%), com duração média dos sintomas de 6,2 dias. Uveítes anteriores e difusas foram associadas com dor ocular (p<0,001). Escotomas e a "floaters" foram mais frequentes na uveíte posterior (p=0,003 e p=0,016, respectivamente). Pacientes com uveíte anterior apresentaram melhor acuidade visual (p=0,025). Precipitados ceráticos granulomatosos foram mais frequentes em pacientes com uveíte posterior (p=0,038). Um diagnóstico etiológico com base na avaliação inicial no serviço de emergência foi possível em 45 pacientes (38,5%). Conclusão: A uveíte anterior aguda foi a uveíte mais frequentemente encontrada no serviço de urgência oftalmológica. A avaliação inicial do paciente forneceu informações suficientes para a conduta terapêutica primária, e possibilitou diagnóstico etiológico em um número considerável de pacientes. .

Implante intravítreo de Dexametasona en uveítis no infecciosa. Resultados clínicos en un grupo de pacientes de la ciudad de Medellín / Dexamethasone intravitreal implant for noninfectious uveitis. Clinical results in a patients group in Medellín

Objetivos: describir los resultados clínicos del uso del implante de dexametasona intravítrea en un grupo pacientes con uveítis no infecciosa de la ciudad de Medellín. Diseño del estudio: estudio descriptivo, retrospectivo y observacional. Métodos: se revisaron las historias clínicas de 19 pacientes con uveítis no infecciosa a los que se les realizó el implante de dexametasona. Se compararon variables clínicas antes de la aplicación, al lograr una mejoría de los parámetros inflamatorios y en la última valoración que tuvieran los pacientes. Se realizaron cálculos de medias y rangos y se aplicó la t de Student pareada para la diferencia de medias de las variables clínicas descritas antes del procedimiento y al lograr la mejoría clínica, y antes del procedimiento y en la última valoración. Resultados: se realizaron 24 implantes de dexametasona en los 19 pacientes. La mayoría de los pacientes tuvieron uveítis intermedia idiopática (42.1%) o panuveitis (42.1%). Se encontró una mejoría de los parámetros inflamatorios en un promedio de 8.39 semanas (rango 4-16 semanas) con una diferencia significativa antes de la aplicación y en el momento de la mejoría, en las variables de agudeza visual (p=0,025), celularidad en cámara anterior (p=0,000), celularidad en vítreo (p=0,000) y opacidad vítrea (p=0,000). Con respecto a la última valoración hubo una mejoría estadísticamente significativa de los parámetros inflamatorios, excepto de la agudeza visual (p=0,331). Conclusión: el implante intravítreo de dexametasona es una alternativa para pacientes con uveítis no infecciosas que no mejoren con tratamiento estándar. A las 8 semanas se observa una mejoría estadísticamente significativa de todos los parámetros inflamatorios, que pueden persistir hasta las 34 semanas, a pesar de que hay pacientes que requieren reaplicaciones y/o continuidad de la terapia sistémica o tópica.

Purpose: to describe the clinical results of intravitreal dexamethasone implants in a group of patients with noninfectious uveitis. Methods: a retrospective analysis of the records of 19 patients with noninfectious uveitis who underwent intravitreal dexamethasone implants was performed to compare clinical measures before the application, during the improvement phase of infl ammatory parameters and in the last visit. Paired t student was used to assess differences of clinical parameters before and after the clinical procedure. Results: nineteen patients were treated with 24 dexamethasone implants. Most of the patients had idiopathic intermediate uveitis (42.1%) or panuveitis (42.1%). Improvement was found in 8.39 weeks (R= 4-16 weeks) in the inflammatory parameters with a significant improvement in visual acuity (p=0,025), anterior chamber cells (p=0,000), vitreous cells (p=0,000) and vitreous haze (p=0,000). Average follow up to the last visit was 39.4 weeks (8-104 weeks) with improvement on these clinical variables with exception of visual acuity (p=0,331). Conclusions: The intravitreal dexamethasone implant is a good alternative for patients with non infectious uveitis who don't get better with the standard treatment or have contraindications for it. Significant improvement in the parameters were observed as early as week 8 and were maintained over 34 weeks, despite there were patients who required reapplications and/or topic or systemic or therapy.

Fibrose sub-retiniana progressiva: relato de casos / Progressive subretinal fibrosis: case reports

A síndrome da fibrose sub-retinina é uma doença rara e considerada como parte de um grupo de condições que recebem a denominação de síndrome dos pontos brancos. No entanto, alguns autores a consideram como uma entidade distinta dessas outras doenças com características próprias. Com os casos apresentados, podemos observar muitas dessas características já descritas, como localização e aspecto clínico das lesões, sua evolução e o prognóstico visual final. Seu diagnóstico é muito importante a se considerar em diversos tipos de uveíte, pois o tratamento precoce pode evitar o acometimento bilateral.

The subretinal fibrosis syndrome is a rare disease and is considered part of a group of conditions that are denominated white dots syndrome. However, some authors consider it like a distinct entity from the others diseases with you own features. With these cases we can behold many features already described, like localization and clinical aspect of the lesion, your evolution and the final visual prognosis. It's diagnostic is very important to consider in a varied type of uveitis, because the treatment can avoid the bilateral involvement.

Espondilite anquilosante e uveíte: revisão / Ankylosing spondylitis and uveitis: overview

O presente trabalho propõe uma revisão de epidemiologia, patogênese, quadro clínico, diagnóstico e tratamento da espondilite anquilosante e sua associação com alteração ocular com a devida condução da doença e suas manifestações. Os autores utilizaram em sua pesquisa os bancos de dados PubMed (MEDLINE), LILACS e Biblioteca do Centro de Estudos de Oftalmologia. A espondilite anquilosante é uma doença inflamatória crônica que acomete preferencialmente o esqueleto axial, podendo evoluir com rigidez e limitação funcional progressiva. Seu início costuma ocorrer por volta da segunda à terceira década de vida, preferencialmente em indivíduos do gênero masculino, caucasianos e HLA-B27-positivos. Sua etiologia e patogênese não são completamente elucidadas, e seu diagnóstico costuma ser tardio. O controle clínico e o tratamento são frequentemente satisfatórios.A uveíte anterior aguda é a manifestação extra-articular mais comum, ocorrendo em cerca de 20%-30% dos pacientes com espondilite anquilosante. Aproximadamente metade dos casos de uveíte anterior aguda está associada à presença do antígeno HLA-B27, podendo ser a primeira manifestação de uma doença reumatológica não diagnosticada, geralmente com boa resposta terapêutica e bom prognóstico. Concluímos que, para melhor avaliação e tratamento dos pacientes com uveíte, é importante maior integração entre oftalmologistas e reumatologistas.

The present article reviews the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of ankylosing spondylitis and its association with ocular changes. The authors used the PubMed (MEDLINE), LILACS, and Ophthalmology Library databases. Ankylosing spondylitis is a chronic inflammatory disease that usually affects the axial skeleton and can progress to stiffness and progressive functional limitation. Ankylosing spondylitis usually begins around the second to third decade of life, preferentially in HLA-B27-positive white males. Its etiology and pathogenesis are not completely understood, and its diagnosis is diffi cult. Clinical control and treatment are frequently satisfactory. Acute anterior uveíte is the most common extra-articular manifestation, occurring in 20%-30% of the patients with ankylosing spondylitis. Approximately half of the acute anterior uveíte cases are associated with the presence of the HLA-B27 antigen. It can be the first manifestation of an undiagnosed rheumatic disease, usually having a good prognosis and appropriate response to treatment. In conclusion, for better assessment and treatment of patients with uveitis, ophthalmologists and rheumatologists should work together.

Managing bevacizumab-induced intraocular inflammation.

The outcome of four cases of sterile endophthalmitis that developed after intravitreal injections of bevacizumab has been reported here. All four eyes received 1.25 mg/0.05 ml intravitreal bevacizumab from 0.2-ml aliquots for different etiologies. The inflammation predominantly involved the anterior chamber with mild vitreous reaction. All patients were culture negative and regained preinjection visual acuity and were culture negative following intravitreal antibiotic administration. This report highlights that intravitreal bevacizumab can cause sterile endophthalmitis and this has to be kept in mind, and clinical judgment should be used to differentiate it from infective endophthalmitis.

Biologic agents in inflammatory eye disease

Non-infectious uveitis is a potentially sight threatening disease. Along the years, several therapeutic strategies have been proposed as a means to its treatment, including local and systemic steroids, immunosuppressives and more recently, biologic agents. The introduction of biologies can be defined as a new era: biologic therapies provide new options for patients with refractory and sight threatening inflammatory disorders. The availability of such novel treatment modalities has markedly improved the therapy of uveitis and considerably increased the possibility of long-term remissions. This article provides a review of current literature on biologic agents, such as tumor necrosis factor blockers, anti-interleukins and other related biologies, such as interferon. alpha, for the treatment of uveitis. Several reports describe the efficacy of biologies in controlling a large number of refractory uveitides, suggesting a central role in managing ocular inflammatory diseases. However, there is still lack of randomized controlled trials to validate most of their applications. Biologies are promising drugs for the treatment of uveitis, showing a favorable safety and efficacy profile. On the other hand, lack of evidence from randomized controlled studies limits our understanding as to when commence treatment, which agent to choose, and how long to continue therapy. In addition, high cost and the potential for serious and unpredictable complications have very often limited their use in uveitis refractory to traditional immunosuppressive therapy

Úvea y enfermedades sistémicas / Uvea and systemic diseases

El ojo, además de entregarnos el sentido de la visión, también nos permite conocer la salud general del organismo. Muchas enfermedades sistémicas se manifiestan en el órgano visual antes, durante o después del debut de ellas a nivel sistémico. Este compromiso visual es variado y depende de la enfermedad en cuestión, destacando la escleritis, uveítis y vasculitis retinales. Conocer el estado ocular permitirá al clínico realizar diagnósticos más asertivos y oportunos, realizar el tratamiento más adecuado y definir pronóstico en varias enfermedades, que tienen al globo ocular como un órgano blanco. El objetivo de esta revisión es atraer la atención del lector sobre el compromiso oftalmológico en varias enfermedades

The eye besides giving us sight, it let us know the general health of the whole body as well. Many systemic diseases become evident in the visual organ before, during or after its systemic onset. The visual involvement in these diseases is wide and depends on the underlying disease. It is worth to stand out the escleritis, uveitis and retinal vasculitis. The knowledge of the ocular health will let the physician to diagnose more accurately and in time, to start the most appropriate treatment and to define the prognosis of several diseases that have the eye as a target organ. The aim of this review is to draw the reader's attention to the ophthalmic involvement in several systemic diseases

Eficacia de infliximab en uveítis severa / Efficacy of infliximab in severe uveitis

La depresión en del adulto mayor es frecuente y poco valorada. Se le considera un problema de salud pública, de prevalenVarón de 42 años que presentó una uveítis severa del ojo derecho, con hipopion, edema retinal y marcada disminución de la agudeza visual. No respondió al tratamiento tópico, esteroides y azatioprina por lo que se le administró infliximab. Se obtuvo una rápida mejoría por lo que se debe considerar este tratamiento en la uveítis severa.

A 42 year-old male patient developed severe uveitis of the right eye with hypopion, retinal edema and marked diminution of the visual acuity. He did not respond to topical treatment, steroids and azathioprine so infliximab was administered. A very good response was obtained so this kind of treatment should be considered for severe uveitis.

Syndrome of tubulointerstitial nephritis and uveitis.

We report a case of acute tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) in an elderly Indian woman. TINU is one of the rare causes of acute tubulo interstitial nephritis and is likely to be missed as there is often temporal gap between the appearance of the renal and ocular manifestations. ©

Tuberculous uveitis at a referral center in southeastern Brazil / Uveíte por tuberculose em um centro de referência no Sudeste do Brasil

OBJETIVO: Descrever a ocorrência de uveíte por tuberculose (UTB) em um centro de referência em Minas Gerais, Brasil. MÉTODOS: Um total de 16 pacientes (idade > 15 anos) atendidos consecutivamente de janeiro de 2001 a julho de 2004 no Centro de Referência de Uveíte do Estado de Minas Gerais para avaliação diagnóstica de uveíte foi selecionado para este estudo. Foram coletados dados demográficos e clínicos, assim como dados sobre avaliação para toxoplasmose, sífilis e doenças reumatológicas, teste tuberculínico e sorologia anti-HIV. RESULTADOS: Dos 16 pacientes, 11 (69 por cento) tinham UTB. História prévia de contato com tuberculose pulmonar foi relatada por 72 por cento (8/11) dos pacientes do grupo com UTB e por 20 por cento (1/5) dos pacientes do grupo sem UTB. Embora a razão de chances para essa associação tenha sido de 10,67 (IC95 por cento: 0,59-398,66), o valor de p apresentou significância limítrofe (0,078). Não houve diferença quanto ao quadro ocular inflamatório e ao resultado do teste tuberculínico entre os pacientes com UTB e os sem UTB. Todos os pacientes tinham sorologia negativa para o HIV e foram acompanhados por 2 anos. CONCLUSÕES: Neste estudo, a história prévia de contato com tuberculose pulmonar foi de grande ajuda para o diagnóstico da UTB.

OBJECTIVE: To describe the occurrence of tuberculous uveitis (TBU) at a referral center in the state of Minas Gerais, Brazil. METHODS: A total of 16 consecutive patients (>15 years of age) who underwent diagnostic evaluation of uveitis between January of 2001 and July of 2004 at the Minas Gerais State Referral Center were selected for study. Demographic and clinical data, as well as data related to screening for toxoplasmosis, syphilis, and rheumatologic diseases, together with the results of tuberculin skin testing and HIV testing, were collected. RESULTS: Of the16 patients evaluated, 11 (69 percent) were found to have TBU. A history of contact with pulmonary tuberculosis was reported by 8 (72 percent) of the 11 patients with TBU and by 1 (20 percent) of the 5 with non-TBU. Although the odds ratio for this association was 10.67 (95 percent CI: 0.59-398.66), the p value was borderline significant (p = 0.078). There was no difference between the patients with TBU and those with non-TBU in terms of the status of ocular inflammation or the tuberculin skin testing results. All of the patients were HIV negative and were monitored for two years. CONCLUSION: In this study, a history of contact with pulmonary tuberculosis proved to be useful in diagnosing TBU.

Tratamento das uveítes / Uveitis treatment

O objetivo deste trtabalho sobre tratamento das uveítes foi tornar para o colega mais rápido o tratamento das várias etioloogias. Não obstante, é necessário antes do procedimento terapêutico o diagnóstico preciso, pois o tempo perdido no tratamento inadequado pode resultar em pior prognóstico visual e aumento da morbidadee e mortalidade.

Oftalmia simpática grave: relato de caso / Severe sympathetic ophthalmia: case report

Os autores apresentam um caso de oftalmia simpática grave pós-facoemulsificaçäo que foi tratado com imunossupressäo sistêmica e enucleaçäo do olho simpatizante. A paciente evoluiu com resoluçäo do quadro inflamatório e melhora da acuidade visual. Os autores discutem quadro clínico, diagnóstico, fisiopatologia e aspectos terapêuticos da oftalmia simpática.